Chat transcript: Women ask about heart disease

May 17, 1999
Web posted at: 12:53 p.m. EDT (1653 GMT)

(CNN) -- Dr. Martha Hill, immediate past president of the American Heart Association, discussed gender differences and heart disease on Friday, May 14, as part of Women's Health Month at CNN.com.

Chat moderator: Heart disease has never been considered a serious problem for women, and we are finding now that it is.

Chat participant: I suppose with more women smoking nowadays, the incidence of heart disease for women is likely to rise.

Chat moderator:Each year 240,000 women in the United States die from heart disease. Heart disease is the second-leading killer of U.S. women over the age of 40, second only to cancer; by age 55, heart disease assumes the lead. By comparison, 90,000 women die annually from stroke, 41,600 from lung cancer, and 40,500 from breast cancer.

Chat participant:Ms. Hill, what is your area of expertise as far as heart disease goes??

Martha Hill: High blood pressure prevention, care and control.

Chat participant: Can you tell us a bit about your philosophy on prevention of heart disease in women?

Martha Hill: It is important that women know if they are at high risk for heart disease. One out of two American women die of heart dieease or stroke. There is a great deal that women can do to reduce their risk of heart disease. Women should NOT smoke. This is the most important thing women can do for their health. Perhaps the second most important thing is for women to know their numbers: their blood pressure, cholesterol, their blood glucose (sugar). In addition, it is important for women to know their weight/height ratio. If women control their weight, identify risk factors early and modify their lifestyle, they can prevent or minimize their risk of heart disease and stroke.

Chat participant: Martha, is there a correlation in the weight-to-height ratio in cases of high blood pressure?

Martha Hill: There is a very strong correlation between body weight and blood pressure. Another way of looking at weight is to calculate the body mass index, which accounts for the weight/height ratio. The higher the weight, the higher the blood pressure, on average. This is important because overweight and obesity are increasing in the United States. Almost half of American adults are overweight and almost one-third of youth. Therefore, we can expect more people to develop high blood pressure.

Chat participant: Do you think there has been prejudice in treatment and/or studies with regard to women's heart health?

Martha Hill: It is true that women were not included in research studies of heart disease until recently. This was because most premature heart attacks, that is, those before age 55, occur in men, and it is tragic for anyone to die at an early age of a disease that might be preventable or treatable. There are two main reasons why women were not in these studies: 1. Women develop heart disease at older ages, and many assumed that it was a natural consequence of aging. 2. Scienists were concerned about the "confounding" caused in studies by women's hormones and with any risk of possible harm caused during pregnancy. However, about 10 years ago, Dr. Bernadine Healy, as director of NIH (National Institute of Health), instituted the Womens' Health Initiative, and subsequently there have been many studies begun which include women.

Chat participant: How do systolic and diastolic readings for men and women differ? Does a woman with 140/90 readings have the same risk as a man of the same age, say 35 years old?

Martha Hill: The systolic and diastolic blood pressures do not differ for men and women. The mechanisms within the body that account for these pressures are exactly the same. Women are at less risk for high blood pressure at younger ages and tend not to develop high blood pressure until midlife.

Chat participant: What is the youngest age at which heart disease can develop in a woman?

Martha Hill: Well, actually heart disease can develop in a female embryo or fetus. So, I would say within weeks of conception if one included congenital heart disease. Many girls, now particularly in developing countries, can develop infectious heart disease, such as rheumatic fever. Typically, women develop coronary artery disease later in life than men -- on the average 10 years later.

Chat participant: How many women die every year worldwide from heart disease? How many in the United States?

Martha Hill: I do not know the worldwide figures, but in the United States about 500,000 women die each year of heart disease.

Chat moderator: How does HRT (hormone replacement therapy) help prevent heart disease? Is this a controversial topic still?

Martha Hill: As soon as I find out I will let you know. There is a great deal of exciting research going on. It may be related to how estrogen affects the lining of coronary arteries or the smooth muscles in the artery walls. It may also relate to estrogen's effect on clotting factors. Until the results of major ongoing research studies come out in the next few years, we will not have definitive information; thus the HRT question will remain somewhat controversial. It is important that women talk with their doctor about THEIR own risk for heart disease and osteoporosis and because of recent data also ask about the benefits of HRT regarding memory.

Chat participant: What type of heart problem am I more likely to develop as a white American woman?

Martha Hill: As a white American woman you are perhaps at risk for high blood pressure and high blood cholesterol. These can be checked and treated with lifestyle and if necessary medication. You also should be aware of your risk for diabetes, which can contribute to coronary heart disease also. Some women have a heart attack, a myocardial infarction, and not know it because they never developed angina, the chest pain caused by less blood in the arteries in the heart muscle, so the muscle is deprived of oxygen and pain is typically caused. There are two increasingly common forms of heart disease that do affect women: abnormal patterns of the heart's rhythms and congestive heart failure.

Chat participant: Can a woman of 31 develop heart disease from obesity?

Martha Hill: Obesity places a major strain on the heart, and it is ossible that somone who is very obese could develop heart disease at an early age. Remenber, obesity also causes high blood pressure, high blood cholesterol and diabetes. Each of these is a major risk factor for heart diesase, and in combination they are even more potent.

Chat participant: My father died last week from heart problems. I am 39 and use Toprol XL (50 mg) (blood pressure medication). What are the risks to my daughter that I should be aware of?

Martha Hill: It is good that you recognize that heart disease and many of its risk factors run in families. This is largely due to genetics, but some of this clustering is due to environment. For example, children who live in homes where one or both parents smoke is more likely to start smoking at a young age. Also sedentary lifestyle, alcoholism, high-fat diet and other lifestyle patterns cluster in families. I suggest that you ask your daughter's pediatrician to answer the question, and you ask your doctor what else you can do not only for yourself but to set a good example for your daughter.

Chat participant: What cultural differences (eating patterns in Americans vs. Europeans, exercise habits, etc.) contribute to heart disease?

Martha Hill: There are very interesting differences. Finland, for example, had the highest heart disease rates in the world. Their diet is mostly meat and fats. In Italy, Greece and Spain, for example, people eat the "Mediterranean Diet," which is very high in fish, olive oil and vegetables. Japan, where people eat a lot of salted fish, has the highest stroke rates in the world.

Chat participant: Miss Hill, does a person with diabetes have a risk of hypertension?

Martha Hill: Hypertension, or high blood pressure, and diabetes can occur together commonly. They are the major causes of kidney failure and major risk factors for coronary heart disease and stroke. Each should be taken seriously and treated.

Chat participant: Can humans get heartworms, and if so, how is it detected?

Martha Hill: This is an interesting question. People can get various worms in their bodies. Typically they injest the worms in foods, but some can enter through the skin.

Chat participant: I suffer from low blood pressure; does this put me at any greater risk for heart disease?

Martha Hill: No, not usually. It is said about low blood pressure that it cannot be too low as long as you are up and about and feeling well.

Chat moderator: What role does folate play in prevention of heart disease? And what is the recommended daily intake?

Martha Hill: I am not an expert on that. We are learning more about the importance of nutrients, and you may find more information by contacting MarthaHill at the American Heart Association Web site at www.americanheart.org.

Chat participant: Do you know of any successful treaments for fibromyalgia?

Martha Hill: No, I don't. But I recommend the American Arthritis Association as a possible source of information.

Chat moderator: What is the leading cause of death in women? Most women will say it's breast cancer. So it comes as a surprise to many people that heart disease is the No. 1 cause of death in both women and men. "One out of two women are going to have, live with, and/or die from heart disease and stroke," said Martha Hill, Ph.D., R.N., a professor at the Johns Hopkins University School of Nursing and immediate past president of the American Heart Association. "It is amazing women are still not getting that message, and one has to ask why."

Martha Hill: This is a VERY important point. You are correct. Two-thirds of U.S. women believe that breast cancer is their major health threat. They are not aware that lung cancer is more common in women than breast cancer. But heart disease and stroke kill one out of every two American women. Please contact the American Heart Association's Web page and look up the Womens' Health Campaign. There is a great deal of information about what women can do to prevent or minimize their risk. The address is www.americanheart.org.

Chat participant: Do you ever see cardiovascular MRI becoming a routine diagnostic for cardiac patients?

Martha Hill: Well, perhps if the cost becomes less of an issue. The new imaging technologies are very interesting, but we still are not sure of the overall cost-benefit at the group or population level. The entire body can be scanned, and a great deal of interesting information can be learned, but it is costly, and one needs experly trained people to do the scan and interpret the results.

Chat participant: Dr. Hill, how does research funding correlate with the mortality rates? Specifically, is cardiovascular disease receiving more funding than breast cancer?

Martha Hill: This is a very important and politically sensitive question. No, research funding does not necessairly correlate with mortality rates. If it did, heart disease and stroke would have a great deal more money. Funding is based upon scientific opportunities, and to an extent that some people find distressing, upon political considerations. Remember Nixon's war on cancer? Today, active and verbal advocacy groups can influence congressional funding allocations for research.

Chat moderator: Hill said women may not know a lot about heart disease because they often see gynecologists, who focus on reproductive health. Also, many doctors are not aware of the risk of heart disease in women, because up until 10 years ago, women were largely excluded from heart disease studies.

Chat participant: I heard that if you have poor dental health it affects your heart.

Martha Hill: Poor dental health can affect the heart if bacteria in the mouth enter the body's bloodstream and settle in the heart. That is why some people with heart disease are told by their dentist to go on antibiotics before dental surgery or a major scaling and cleaning.

Chat participant: Why so much focus on women's health as of late? Ten years ago I don't think we would have heard about heart disease in women at all.

Martha Hill: The increased focus is due, in part, to women being more assertive about their health. Women today want answers and to be more proactive about taking care of themselves. American women can expect to live into their 80s, and they want to be as active and healthy as possible. They are demanding facts and evidence about how best to care for themselves. And the research and health care systems are responding. Just look at all of the womens' health centers that have sprung up in the past two to three years.

Chat moderator: Any final comments for our chatters?

Martha Hill: I encourage every woman to take care of the inside of her body as she does for the outside. Be aware. Know your numbers and what they mean. Talk with your doctor - be assertive about what you need and need to do to take excellent care of yourself.

Chat moderator: Thank you, Martha Hill, for raising our awareness on the subject of heart disease in women as part of Women's Health Month at CNN.com.